I think it should be an interesting debate & here are my views:
Most GP surgeries are fully electronic. They would really like the radiology report to be sent to them electronically in their GP system. GP must be able to create a worklist for the unread reports within their GP systems and take action as required. Access to images would be nice when we have achieved the report transfer & cost benefit is analysed for success.
Currently most hospitals send reports in paper format which are then scanned in GP systems (PUSH sharing). This is due to lack of standards adoption for electronic systems.
This is where I believe the FUTURE lies--"PUSH sharing." 1. Transfer of reports from RIS/VNA to GP system using XDR. RIS/VNA must be a XDR source and the GP system a XDR recipient. 2. We could also include images by XDR-I adoption by the sending & receiving systems in the hospital & GP surgeries.
To return to Keith's original question: "has your Trust provided GP’s and other primary care or community based / cottage hospital clinical staff with access to your PACS directly via the web browser or indirectly via Burnbank Image Exchange Portal, or other method? " What is being discussed here is a "PULL SHARING"--whether PACS web access or Burnbank image portal. 1. PULL method of sharing brings about a host of information governance issues--ability for surfing the PACS archive by staff not employed by the organization--and thus the ability to deal with any investigations of confidentiality breach etc 2. PULL method of sharing is very dependent of network. Whilst it works in a hospital environment, with most PCs connected over a 100Mbps connection, it becomes useless over a low bandwith N3 connection--so even the initially enthusiastic GPs find themselves not using web access to images.
To summarise, I think electronic access to radiology images & reports to GPs is a really good idea. 1. If you had to choose what to do first---reports before images is clearly the answer. 2. Push method of sharing with GP is preferable to pull method of sharing. 3. Always use global interoperability standards when setting up communications between multivendor IT systems. PUSH & PULL SHARING discussed by Dave Harvey. http://www.pacsgroup.org.uk/forum/messages/195/Point_to_Point_transfer-70327.pdf
My thoughts on the above points are: There are 5 GP systems in Cornwall, all of which import path & x-ray reports - Microtest, Emis, Isoft, InPractice and TTP. The GPs receive their x-ray reports in a daily PMIP-dump along with all the path results etc. Most GPs don't need a 'worklist' because they rarely get back more than about 5 (x-ray) reports on an average day. They are mainly happy to read the reports and will only look at the images on PACS if 1) they have a patient with them & it helps explain the diagnosis, 2) out of professional curiosity, 3) if the result is signficantly at variance with what they were expecting or 4) if they are waiting for an urgent result but it hasn't appeared on their GP EPR system yet but might be attached to the PACS images. That said they hugely value being able to view PACS images when required and I have big issues with this PULL and PUSH debate. I can see both sides of the information governance requirements but why are GPs, who are are bound by the rules and conduct regulations of the GMC to be treated less favourably than any Tom, Dick or Harry who can get a job in an acute Trust and browse over other staffs' shoulders or, heaven forbid, interrogate the system once the other staff member fails to log off.(This never happens in reality of course!).
Naturally, I agree with the statement about interoperability of standards between IT vendors.
I just want to reassure everyone who is reading this public forum, the acute Trusts do take IG access seriously.
Regarding Push & Pull sharing this happens today successfully between Acute Trusts & GP surgeries.
1. PUSH-- Types: GP referral letter, GP requests etc Trust clinic letters, discharge summaries, lab results, reports etc Transport Mechanism Paper & post largely PMIP-- for labs predominently, sometimes for radiology, does not support transport of doc, formatting is lost so not easy to read long documents by the recipient Other electronic methods--? Secure email ( are Trust & GPs using this). We use Medisec for clinic letters. STANDARD: Whilst electronic methods exist for push method of sharing, there is a lack of a document push standard. Whilst PMIP has existed since 1990s it has seen adoption by 2 vendors only--ICE & Indigo. Compare this with global adoption of DICOM by a huge number of vendors. Hence, my interest in global standard of XDR which will allow vendor neutral push sharing in NHS.
PULL Again this is well established & works with ICE & Indigo. Interop functionality allows GPs pull access into ICE database to that particular patients records. Whist within the Trusts one can search for any patient through the GP system one can only have access to those patients who are registered with the GP. As data here is text based access is instant. Similar interop type functionality can be created beween GP system & PACS --simple context link--passing patient & user context. However, currently one would struggle with bandwidth at the moment. However, with improving bandwidth for home use--50 mbps for us, this would not be an issue in the future.
I think push & pull sharing exist in NHS and will continue to used. I think the key issue is sharing should be standards based & vendor neutral. NHS must adopt global interoperability standards.
We have a very elegant means of providing GPs with access to reports and key images (and also basic axial view of diagnostic exams) plus all document types that accumulated during the patient's care (EKG's, Dr notes, etc.)
This is an HTML5 based referential portal, so the GP doesn't have to install anything at their end. They can also access it via any mobile device; Apple or Android.
Our solution supports the push/pull model for DICOM and HL7.
I've read a few articles online about the benefits of sharing exams (not just images) with GPs. Personally, I think the benefits extend further than just GPs. It's all about the patient at the end of the day so if you can give anyone involved in their care a window into their blob of information - surgeons, MDT specialists, medico-legal experts - anyone involved in the well being of the patient. The more healthcare professionals able to review a case, the more solid the decision/arguably the outcome, and this is probably why cancer institutions champion the idea (where you have multi-disciplinary specialists collaborating). This also follows a true patient centric model where their blob of information is held by them and they control who has access to it (and that's exactly what we try and do).
InHealth seem to be the provider to talk to about this (we have no commercial affiliation with them, they really are). Here are links to the articles:
posted on Wednesday, June 20, 2012 - 06:25 pm
In response to Ronald Greeff, the articles you quote are about GP access to IMAGING not images, i.e. GPs being able to request diagnostic imaging tests themselves rather than having to refer the patient to a hospital specialist who then requests the test.
I doubt most GPs would consider themselves competent to interpret or report images(paticulary if they are viewing them on handheld devices!), especially if they considered the possibility of litigation if they were to make a mistake.
I have to agree with Neelam that most would probaly consider access to reports more of a priority.
My personal view is that care of patients with chronic conditions is adversely affected by imaging being done in several different places making it very difficult to plan treatment at, for example, the cancer centre when reports and images required for comparison have to be collected from different sites rather than all being available at the same site.
Michel Pawlitz (Karos Health) a DICOM & CDA standards expert working with Canada Infoway project for his views on this. He has been a speaker at our meetings too. I think what he wrote to me on email is a very wise view coming from a non-medical person---
"The report is the most important part to communicate within the health community and if there is interest to look at the images based on the report, images should be made accessible but that is only required as a second step."
In my view this is what should happen with GPs 1. Push ELECTRONIC transfer of radiology reports to GP systems--using XDR & CDA preferably 2. Ability to "view or stream" relevevant images held in the hospital PACS should the GP wish to access these images